This month we’re kicking off a new blog series! Every other month through 2019 we will highlight a different autoimmune disease and the impacts it has on oral health, and vice versa. Autoimmune diseases are wide ranging and affect many different systems of the body. Their commonality though, is that the body attacks its own cells wreaking havoc and causing painful and sometimes debilitating symptoms. Over 23.5 million people in the United States alone suffer from at least one autoimmune disease. These diseases are seen more often in women than in men, and it is thought that hormonal changes may play a role. We’ll be starting the series off this month taking a look at the impact of Rheumatoid Arthritis (RA) on oral health.
There are currently a couple of different hypotheses as to why so many individuals with RA also suffer from periodontal disease. One such hypothesis presents an easy connection. RA can cause severe pain and stiffness in any of the body’s joints. Painful hands with limited mobility make brushing and flossing more difficult. If RA also affects the TMJ, this can limit the patient’s ability to open, which further complicates keeping teeth clean. A lack of good homecare can certainly increase one’s risk for developing periodontal disease. Poor homecare may not be the exact link, but it is certainly a risk factor shared between periodontal disease and RA.
A German study in 2008 found that patients with RA were 8 times more likely to develop periodontal disease and also noted that poor oral hygiene alone did not explain such a significant increase in risk. This of course leads us to look deeper into the disease on a cellular level.
Similarities have been found in oral tissue with periodontal disease and joints with RA. As we well know, the inflammation of periodontal disease causes destruction of the bone and tissue surrounding the teeth. Inflammation is also what causes the breakdown of joints, and discomfort associated with RA. Many of the same proinflammatory proteins were found in both diseases (Tumor Necrosis Factor (TNF), Interleukin-1, and Interleukin-6). A different study from Israel also found that genetics may play a role in elevated risk for RA.
All of this information and more has led us to better understand the entire disease process. One of the early markers of RA is the increase of antibodies to citrullinated peptides. Citrullination is the scientific term, for a change in cell structure that leads it to be seen as a foreign entity to the body. This citrullination leads the body to release anti-cyclic citrullinated (anti-CCP) antibodies. These antibodies then attack the cells thought to be foreign, even though they are in fact cells of the body. The similarity to periodontal disease comes through a link in bacteria. It was found that at least one strain of bacteria commonly associated with periodontal disease initiates the process of citrullination. A study in 2009 concluded that due to these facts, certain oral bacteria could be the cause of RA and/or that periodontal disease may be inducing the disease process of RA.
One can assume then that with all of this information, periodontal disease and rheumatoid arthritis are absolutely linked. One of the best ways to control each disease is to be sure to treat them. If you are suffering from uncontrolled periodontal disease you will likely benefit from scaling and root planing as well as maintaining better oral health with frequent dental visits. It is also important to work with your physician to control your RA. If you suffer from RA and have a difficult time with homecare due to stiff or painful joints, speak with your hygienist. You may benefit from different dental tools, including an electric toothbrush or water flosser.
We believe in the whole body wellness model and strive to work closely with our patients’ physicians. If you have RA, it is important to maintain good homecare and frequent visits with your hygienist. Over the coming months, we look forward to highlighting other autoimmune diseases. They are not spoken about often, taking a backseat to Smoking and Diabetes when it comes to periodontal disease. It is our hope that continued studies will be done to further understand the etiology of these elusive diseases. If you know someone with RA, please share our post with them!
Johns Hopkins Arthritis Center
National Library of Medicine, National Institutes of Health